Multidisciplinary Approach Shrinks Glioma, Elevates Quality of Life

While briefly hospitalized for evaluation, Bruce Davis chatted with a fellow patient who was far along in his treatment for cancer at the University of Chicago Medicine.

Davis still remembers their July 2010 conversation: “He told me, ‘The doctors here will have a plan for you. Have faith and work through it.’ He was sincere and I trusted him. I decided to believe in what he said.”

In the months before, Davis, 59, experienced a long list of worrisome symptoms, including double vision, dizziness, problems with balance, and drooping of both his left eye and the right side of his face. His primary care physician in the northwest suburbs of Chicago ordered an MRI. When the scan revealed a lesion on his brain stem, Davis came to the University of Chicago Medicine.

I felt like I was fighting back with the help of Dr. Lukas and Dr. Chmura.

“I knew it was an excellent teaching hospital and respected it as the best in the area,” said Davis, a resident of Lake Zurich. He was formerly a graduate student at the University of Chicago in the 1970s and received treatment here in the 1990s.

After undergoing sophisticated imaging studies offered here at the medical center, he met with neuro-oncologist Rimas Lukas, MD, an expert in central nervous system tumors. Lukas explained that several neuroscientists would discuss Davis' case and work together to diagnose and treat him.

“Dr. Lukas assembled a team overnight,” Davis said. “He spoke sensibly and answered all of my questions. He calmed me down and gave me hope.”

Determining a Diagnosis

Lukas told Davis that the studies pointed to a brain stem glioma, but a biopsy was necessary to definitively identify its type and grade. Because of the brain stem’s location and function, the biopsy would involve an intricate surgical procedure.

“The brain stem is where all of the wires from the brain come down and connect with the spinal cord,” Lukas explained. “It allows you to move and perform other vital functions, such as breathing, coordinating eye movements and eating.”

They saved my life, saved my sanity and added to the quality of my life.

Before moving forward, Davis decided to get second opinions. “After all, I had a brain tumor in the ‘Grand Central Station’ of my brain,” he said. “I believed it was appropriate to hear from other experts. Dr. Lukas encouraged me in this.” Three major cancer centers in the country agreed with the University of Chicago Medicine approach.

Using imaging guidance, a neurosurgeon performed the biopsy, removing a tissue sample the size of the tip of a pencil. The mass was infiltrating into the brain stem and there was no clear boundary between normal and abnormal tissue.

Neuro-pathologists at the University of Chicago Medicine determined the tumor was an astrocytoma, which is a type of glioma. While the tumor was low-grade (slow-growing), the critical location and infiltrating nature meant it could not be surgically removed.

Targeting the Tumor

Lukas recommended an aggressive treatment protocol that included a combined radiation and oral chemotherapy regimen for six weeks, followed by 12 cycles of oral chemotherapy over 12 months.

Radiation oncologist Steven Chmura, MD, PhD, used advanced techniques to shrink the tumor. Image-guided radiation therapy (IGRT) provided real-time pictures of the structures in the brain while delivering radiation beams contoured to the shape of the tumor, allowing Chmura to directly target the tumor with powerful radiation while sparing healthy brain tissue.

“The radiation was never painful and I was never sickened by the chemotherapy,” said Davis, who continued to work full time as the managing director of a tax consulting firm in Chicago while receiving his therapy. “In a way, I looked forward to my daily radiation treatments. I felt like I was fighting back with the help of Dr. Lukas and Dr. Chmura.”

Regular scans during therapy revealed a progressively shrinking tumor. At the end of treatment in March 2012, an MRI showed it was less than half its initial size.

Left: The tumor on Davis' brain stem before treatment. Right: Davis' tumor after treatment, less than half its original size.

While most of Davis’ symptoms disappeared, he still struggled with double vision in his distance eyesight. University of Chicago Medicine neuro-ophthalmologist Jeffrey Nichols, MD, corrected the problem with inexpensive prisms inserted into Davis’ regular glasses. This remedy enabled him to see well enough to drive.

Davis says he feels “very much indebted” to the University of Chicago Medicine for the care he received. “The nurses, the technicians and staff are all kind and understanding,” he said. “And the doctors are compassionate and dedicated. They saved my life, saved my sanity and added to the quality of my life.”